Provider Demographics
NPI:1083951545
Name:BRIAN K ROUNDS DDS, PS
Entity type:Organization
Organization Name:BRIAN K ROUNDS DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-491-5880
Mailing Address - Street 1:1407 COLLEGE ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2655
Mailing Address - Country:US
Mailing Address - Phone:360-491-5880
Mailing Address - Fax:360-491-6820
Practice Address - Street 1:1407 COLLEGE ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2655
Practice Address - Country:US
Practice Address - Phone:360-491-5880
Practice Address - Fax:360-491-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600306511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty